Cancer patients experience many troubling symptoms during treatment, including pain, insomnia, depression, and anxiety. However, symptom burden is not equally shared across racial/ethnic groups, with Black cancer patients reporting greater symptom burden than their White counterparts. Such disparities in symptom burden are particularly concerning as poorly managed symptoms contribute to lower health related quality of life and worse clinical outcomes. It is also well established, across multiple studies, that minorities report worse health care access (HCA) than Whites, leading to disparities in health care outcomes. However, understanding of the contribution of multiple, co-occurring HCA challenges to health care inequities is lacking, as is evidence on the contribution of HCA to symptom burden inequities. My long-term goal is to become an independent researcher with expertise in addressing inequities in supportive cancer care (i.e., care that optimizes comfort, function, and social support across the cancer care continuum) through the use of innovative health informatics tools that address systemic barriers to care. In collaboration with my mentoring team, I have developed a training and research plan to achieve my career goal. Specifically, I will acquire intensive training in 1) structural equation modeling approaches relevant to disentangling mediators of cancer care inequities; 2) health informatics integration in clinical practice; 3) the application of patient-reported outcomes (PROs) in supportive cancer care; and 4) longitudinal intervention study design and evaluation. I will leverage my career development training to identify subgroups of cancer patients with similar HCA experiences, and examine the contribution of HCA to racial differences in symptom burden in a cohort of Black and White cancer patients enrolled in the North Carolina Health Registry Cancer Survivorship Cohort. With this understanding, I will then develop and test the feasibility and acceptability of an electronic patient-reported outcome (e-PRO) tool designed to routinely monitor both, symptoms and HCA in a cohort of Black and White cancer patients. Existing e-PRO tools rarely collect data on HCA and, to my knowledge, have not been evaluated in racially-diverse cancer patients, potentially leading to missed opportunities for identifying and addressing access-related challenges that might underlie or exacerbate disparities in symptom burden. The rationale for this project is that routinely monitoring symptoms and symptom- relevant HCA over time will lead to more timely and patient-centered symptom management, especially among Black cancer patients who report greater symptom burden and worse HCA relative to Whites.
This proposal addresses a serious and understudied gap in supportive cancer care: effective strategies for mitigating racial disparities in cancer-related symptom burden. Specifically, the proposed research will elucidate the contribution of health care access inequities to racial disparities in symptom burden in order to inform the development of a novel electronic patient-reported outcome (e-PRO) tool designed to routinely monitor symptoms and symptom-relevant health care access challenges. The proposed e-PRO tool has the potential to prompt more equitable provision of supportive care services and lead to improved cancer care outcomes among racial/ethnic minorities experiencing excess symptom burden and more barriers to care.
